Benefit Design

Essential Benefits Package

  • Essential health benefits packages have been created that provide a comprehensive set of services, covers at least 60% of the actuarial value of the covered benefits, limits annual cost-sharing to the current law HSA limits ($5,950/individual and $11,900/family in 2010), and is not more extensive than the typical employer plan.
    The Secretary is required to define and annually update the benefit package through a transparent and public process. (Effective January 1, 2014)
Small groups
  • All qualified health benefits plans, including those offered through the Exchanges and those
    offered in the individual and small group markets outside the Exchanges, except grandfathered
    individual and employer-sponsored plans are required to offer at least the essential health benefits package. (Effective January 1, 2014)

 

Abortion Coverage

Abortion coverage is prohibited from being required as part of the essential health benefits package.
(Effective January 1, 2014)

 

 



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